1. Field of Invention
Embodiments of the invention relate to reducing fraud in prescription healthcare programs using a smartcard.
2. Description of Related Art
Government agency providers of benefits experience difficulties, such as fraud, as a result of persons “double dipping” in government programs. In addition, service providers can inadvertently “double bill” or inappropriately bill for services rendered. Further, proper service and goods providers for government benefits programs frequently wait long periods of time to get paid for their services or goods rendered to the eligible person, such as employees. This situation has become tedious and causes benefit costs to be very high, reducing overall benefits available due to these fraud issues.
Methods and apparatus exist in an attempt to streamline the insurance claim payment process, such as the method disclosed in U.S. Pat. No. 6,163,770. This patent discloses using a digital electrical apparatus to generate output for insurance documentation for a first insurance policy having a first risk and claims while revealing a concurrent second insurance policy for a second risk, wherein the second risk is different from the first.
The processor of this method is connected to a memory device for storing and retrieving operations including machine-readable signals in the memory device, to an input device for receiving input data and converting the input into input electrical data, to a visual display unit for converting output electrical data into output having a visual presentation, to a printer for converting the output electrical data into printed documentation, wherein the processor is programmed to control the apparatus to receive the input data and to produce the output data by steps including: inputting actuarial assumptions defining the first insurance policy; and computing a value of a specific financial attribute of the first insurance policy; the method further including the step of inserting the value of the financial attribute in the first insurance policy and other printed documentation related to the first insurance policy. However, this method did not apply to government programs in a simple and direct manner, as with the system disclosed herein, which was designed to meet these needs.
Therefore, a need exists for a system where the government advances funds to pay for the services of a service or goods provider, and as a result, an eligible person does not have to handle money in order to receive benefits. This need is particularly great for incapacitated persons, such as those in nursing homes, who are no longer able to handle funds or complicated transactions.
Additionally, a need exists for a method to reduce the magnitude of transaction costs involved in reviewing and adjudicating payment requests to a governmental agency. Such a method would reduce the rate of increase of government benefit costs and/or enable more benefits to be provided to more people. Furthermore, a method is needed to reduce the traditionally high cost of benefits administration, including the review and adjudication of payment requests which results from benefit service or goods providers having to act as “banks” or “credit sources” for persons eligible for the benefit.